Provider Demographics
NPI:1891760088
Name:MCQUEEN, YVETTE M (MD)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:M
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 15324
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1088
Mailing Address - Country:US
Mailing Address - Phone:904-382-6907
Mailing Address - Fax:904-268-3259
Practice Address - Street 1:11250 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 15324
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1088
Practice Address - Country:US
Practice Address - Phone:904-382-6907
Practice Address - Fax:904-268-3259
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83280207P00000X
MI4301072139207P00000X
IN01070962A207P00000X
MO2008026698207P00000X
VA0101243606207P00000X
GA62749207P00000X
DCMD041883207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03878OtherBCBS
FL262768000Medicaid
H51358Medicare UPIN
FL03878AMedicare ID - Type Unspecified